Corneal excision or scoring device

ABSTRACT

Disclosed is a corneal excision or scoring device. In one embodiment, the device includes a stabilizing portion having a first opening adapted to encircle an eye, such that at least a portion of the stabilizing portion engages the conjunctival formix of the eye when inserted. The device may also include a second opening adapted to receive a cutting portion having a cutter capable of cutting or scoring the eye. In another embodiment, the device includes a stabilizing portion having an interior with a stop and an exterior serrated edge formed from a plurality of teeth. The stabilizing portion becomes inserted in an eye, such that the serrated edge rests on a sclera of the eye. Next, a cutting portion becomes inserted into the stabilizing portion to cut or score the eye, and the stop limits the distance the cutting portion may be inserted. Related methods are also disclosed.

This application is a divisional of U.S. application Ser. No. 11/452,017entitled “Corneal Excision or Scoring Device,” filed on Jun. 13, 2006,which claims the benefit of U.S. Provisional Application No. 60/690,606filed Jun. 15, 2005 and U.S. Provisional Application No. 60/761,177filed Jan. 23, 2006, the disclosures of which are incorporated herein byreference.

TECHNICAL FIELD

The present invention relates generally to the surgical arts and, morespecifically, to a corneal excision or scoring device.

BACKGROUND OF THE INVENTION

In performing cornea surgery or transplants, such as keratolimbalallograft (KLAL), deep lamellar endothelial keratoplasty (DLEK), orpenetrating keratoplasty (PKP), at least a portion of the cornea of thedonor and the recipient is removed. Generally, a technician or otherwill use scissors, such as the commonly known castroviejo scissors, toobtain transplant material from a donor. Once the transplant materialhas been obtained, a surgeon will use a tool often referred to as a“trephine” to remove a damaged region of a recipient's eye and thusprepare an area to receive transplant material from the donor. Thesurgeon will use a similar trephine device to obtain a portion of thetransplant material (sometimes referred to as a “button”). At thispoint, the surgeon may place the button into the receiving area of therecipient's eye. Once in place, the surgeon may use micro-sutures,biomedical adhesive material, or other means to hold the button.

Due to the delicate nature of the eye and the transplant procedure, thetechnician must use extreme care in order to obtain the proper amount oftransplant material without damaging it. If too deep an incision ismade, the vitreous humor may become ruptured, therein collapsing the eyeand damaging the potential transplant material.

Previous devices, such as the castroviejo scissors mentioned above,require the technician to make multiple “freehand” cuts in the eye. Thisoften results in uneven cuts and inconsistent amounts of transplantmaterial. These devices do not include provisions for stability of thedevice, thus further contributing to the inconsistent amounts oftransplant material obtained. Also, these devices fail to includereliable provisions for measuring or limiting the depth of the cut. Thiscan result in cutting either too little or too much transplant material.If too little material is cut, the transplant procedure may beineffective and the transplant material may be ruined. If too muchmaterial is cut, the vitreous humor may become ruptured and thetransplant material may be damaged, as previously mentioned. Therelative unprecise nature of these devices results in increasedlikelihood of damage to the transplant material and recipient.

Accordingly, the surgical arts have need for a corneal excision devicethat enables the user to obtain consistent amounts of material in asingle cut of the eye. The device should also include provisions toensure accurate cutting depth. Finally, if the eye socket is too smallto place the entire device on the eye, the device should function toscore the cutting area of the eye so that the technician, surgeon, orother can have a guide for using scissors or other traditional surgicaltools to remove the transplant material.

SUMMARY OF THE INVENTION

In accordance with the purposes of the present invention as describedherein, a new and improved corneal excision or scoring device isdisclosed. One embodiment of the present invention includes astabilizing portion having a first opening adapted to engage theconjunctival formix of the eye when inserted in the eye, and a secondopening adapted to receive a cutting portion having a cutter capable ofcutting or scoring the eye.

The stabilizing portion is substantially hollow and the diameter of thefirst opening is greater than the diameter of the second opening. Aflared region of the stabilizing portion may include the first opening.In one embodiment, the stabilizing portion and the cutting portion aresubstantially concentric tubes, and the cutter is a substantiallycircular blade having an uninterrupted edge. The tube of the cuttingportion further includes a projection positioned between the cutter anda gripping portion, the projection limits the depth of the cutting orscoring when it engages at least a portion of the stabilizing portion.The projection may comprise a substantially circular rim having adiameter greater than a diameter of the substantially cylindrical tube.In one embodiment, the stabilizing portion includes a gripping portionat one end and a flared region at the other end, the flared regionassisting a user in engaging the stabilizing portion with theconjunctival formix.

In accordance with another aspect of the invention, the corneal excisionor scoring device comprises a stabilizing portion having a surface, thestabilizing portion becoming inserted in the eye to manipulate theposition of the eye; and a cutting portion having a substantiallyuninterrupted sidewall positioned between a cutter and a projectionpositioned on an exterior of the sidewall, the cutting portion becominginserted into the stabilizing portion to cut or score the eye.Engagement of the projection with the surface of the stabilizing portionfunctions to limit the distance the cutting portion may be inserted intothe stabilizing portion. In one embodiment, the stabilizing portion andthe cutting portion are substantially hollow concentric tubes.

Also, the stabilizing portion may have a first opening adapted toencircle an eye, such that at least a portion of the stabilizing portionengages the conjunctival formix of the eye when inserted in the eye.

In this configuration, the stabilizing portion also has a second openingadapted to receive the cutting portion, the diameter of the firstopening being greater than the diameter of the second opening. Also, theprojection may comprise a substantially circular rim having a diametergreater than a diameter of the substantially hollow tube of the cuttingportion.

In another aspect of the invention, the corneal excision or scoringdevice comprises a cutting portion having a cutter and a projectionspaced apart from the cutter; and a stabilizing portion having aninterior with a stop and a serrated edge formed from a plurality ofteeth. The stabilizing portion may become inserted in an eye, such thatthe serrated edge rests on a sclera of the eye, the cutting portion thenbecomes inserted into the stabilizing portion to cut or score the eye,and the stop limits the distance the cutting portion may be inserted.

The stabilizing portion and the cutting portion may comprisesubstantially hollow concentric tubes. Also, the projection may comprisea substantially circular rim having a diameter greater than a diameterof the substantially hollow tube of the cutting portion. In oneembodiment, the stop comprises a projection, while in anotherembodiment, it comprises a recess. The cutting portion and stabilizingportion may each have matching threads, thereby enabling a user tomechanically join the cutting and stabilizing portions. In oneembodiment, the substantially circular rim resides between the threadson the cutting portion and a gripping portion.

In accordance with another aspect of the invention, a method of cornealexcision or scoring is disclosed. The method comprises engaging theconjunctival formix of the eye and cutting or scoring the eye. Theengaging step may comprise encircling the eye. In one embodiment, theengaging step comprises inserting a stabilizing portion of a cornealexcision or scoring device into the eye, such that a portion of thestabilizing portion engages the conjunctival formix of the eye. Thecutting or scoring may comprise inserting a cutting portion into thestabilizing portion to cut or score the eye.

In another embodiment, the method comprises aligning a stabilizingportion of a corneal excision or scoring device on an eye; inserting thestabilizing portion into the eye, such that a portion of the stabilizingportion encircles the eye and engages the conjunctival formix of theeye; manipulating the eye to a desired position; and inserting a cuttingportion into the stabilizing portion to cut or score the eye. The stepof inserting the cutting portion may comprise inserting until aprojection engages a stop. The inserting the cutting portion step mayalso comprise inserting the cutting portion to cut or score an area 2-4mm away from a limbus of the eye. The inserting the stabilizing portionmay comprise inserting a stabilizing portion having an openingpositioned in a flared region.

In the following description there is shown and described one possibleembodiment of this invention, simply by way of illustration of one ofthe modes best suited to carry out the invention. As it will berealized, the invention is capable of other different embodiments, andits several details are capable of modification in various, obviousaspects all without departing from the invention. Accordingly, thedrawings and descriptions will be regarded as illustrative in nature andnot as restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings incorporated in and forming a part of thespecification, illustrate several aspects of the present invention, andtogether with the description serve to explain the principles of theinvention.

In the drawings:

FIG. 1 is a side view of a corneal excision or scoring device formingone possible embodiment of the present invention;

FIG. 2 is an exploded side view of the device of FIG. 1;

FIG. 3 is a representative partial cutaway side view of an eye;

FIG. 4 is a side view showing one method of use of the device of FIG. 1;

FIG. 5 is a sectional view along the line X-X of FIG. 1;

FIG. 6 is a partial perspective view of one embodiment of a stabilizingportion;

FIG. 7 is a perspective view of a second embodiment of a cornealexcision or scoring device of the present invention;

FIG. 8 is a side view of one possible embodiment of a stabilizingportion of the device of FIG. 7;

FIG. 9 is a side view of one possible embodiment of a cutting portion ofthe device of FIG. 7;

FIG. 10 is a side view of the device of FIG. 7;

FIG. 11 is a bottom view of the device of FIG. 7;

FIG. 12 is a top view of the device of FIG. 7;

FIG. 13 a is a sectional view along the line X1-X1 of FIG. 10 showingone embodiment of assembly of the device of FIG. 7;

FIGS. 13 b-13 d are sectional views along the line X1-X1 of FIG. 10showing one embodiment of a method of using the device of FIG. 7; and

FIG. 14 is an exploded side view of a corneal excision or scoring deviceforming a third possible embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

FIGS. 1-2, 4-6, illustrate one embodiment of the corneal excision orscoring device 10 of the present invention. With particular reference toFIGS. 1 and 2, the device 10 includes a cutting portion 12 and astabilizing portion 14.

The cutting portion 12 comprises a substantially cylindrical tube 16having a gripping portion 18 at one end and a cutter 20 at the other.The gripping portion 18 may include a plurality of knurls for assistingthe user in manipulating the device. In one embodiment, the cutter 20may take the form of an uninterrupted surgical blade substantiallyfollowing the perimeter of the tube 16. The cutter 20 may be formed asone piece with the tube 16 or it may be attached to the tube 16 afterforming via friction fit, brazing, welding or otherwise. Also, thecutter 20 may have any diameter, but preferably has a diameter D₁ (FIG.2) between 15-19 mm. This enables the user to cut or score an area 2-4mm away from a limbus L of the eye, thereby creating a substantiallyuniform rim of sclera material around a cornea. However, differentdimensions of the cutter 20 enable the device 10 to be used withdifferent size eye/eye sockets.

The cutting portion 12 may be formed from any material. In oneembodiment, the tube 16 and gripping portion 18 are formed from atransparent or semi-transparent polymer material. Such a materialprovides the user of the cutting portion 12 with the maximum visibilityof the eye when operating the device 10. Preferably the cutter 20 isformed from a surgical grade metal.

In one embodiment, the tube 16 has a substantially uninterruptedsidewall creating a smooth outer surface 16 a so that the cuttingportion 12 may become inserted into the stabilizing portion 14, asdiscussed below in further detail. Accordingly, the tube 16 preferablyhas a diameter D₂ less than a diameter D₃ of an opening 25 b of asubstantially cylindrical region or tube 25 of the stabilizing portion14. One will appreciate the tube 16 and the tube 25 are substantiallyconcentric when the cutting portion 12 is inserted into the stabilizingportion 14. The cutting portion 12 also includes a projection, such as acircular rim 24, positioned between the cutter 20 and gripping portion18. Preferably the rim 24 has an outer diameter slightly larger than thediameter D₂ of the tube 16 and the tube 25 of the stabilizing portion14. As discussed below, the rim 24 engages a surface, such as the topsurface 29, of the stabilizing portion 14, therein functioning as a stopto the limit the distance the cutter 20 may be inserted into the eye.Accordingly, the rim 24 may be positioned at any point along the tube 16depending on the depth of cut desired.

With specific reference to FIGS. 2 and 6, the stabilizing portion 14includes the tube 25 having the first opening 25 a, a second opening 25b, a second gripping portion 28 at one end of the tube 25, and a flaredregion 27 having a stabilizer 30 at the other end. As shown, thestabilizer 30 comprises a substantially smooth or rounded edge 31positioned at the end of the flared region 27. However, this edge 31 maybe serrated, as discussed below. As shown, the diameter D₄ of the firstopening 25 a is greater than the diameter D₃ of the second opening 25 b.In one embodiment, the diameter D₄ is approximately 24 mm, while thelength L₁ of a wall 33 of the flared region 27 is approximately 10 mm(FIG. 6). These dimensions are preferable when a portion of thestabilizer 30 will contact the conjunctival formix, as discussed belowin further detail. However, D₄ and L₁ may be any dimension. Similar tothe first gripping portion 18 on the cutting portion 12, the secondgripping portion 28 may include a plurality of knurls positioned aboutthe circumference of the tube 25.

As shown in FIG. 14, the flared region 27 may include a plurality ofapertures 35. These apertures enable a user to better visualize thealignment of the corneal excision or scoring device 10 with the eye E.Alternatively, the flared region 27 may be substantially solid, as shownin FIGS. 1, 2, 4, and 6. Similar to the cutting portion 12, thestabilizing portion 14 may be formed of any material, but wouldpreferably be a transparent or semi-transparent polymer. Again, thistype of material provides the user with the greatest visibility of theeye E when operating the device 10.

A description of the assembly and method of use of the device 10 is nowprovided. To use the device 10, a user first aligns the stabilizingportion 14 on the eye and inserts it into the eye socket (FIG. 4). Giventhe appropriate diameter D₄ and the flared region 27, the stabilizingportion 14 encircles a portion of the eye E and may engage theconjunctival formix C (FIGS. 3 and 4). One will appreciate that at leasta portion of the stabilizing portion 14 touches the sclera S of the eyeE. Accordingly, the stabilizing portion 14 functions to secure the eye Ein place for cutting. It also enables a user to manipulate the eye to adesired position before cutting or scoring the eye.

After insertion of the stabilizing portion 14 into the eye E, the userbegins insertion of the cutting portion 12 into the stabilizing portion14 in the direction of the action arrow A in FIG. 4. The user continuesto insert the cutting portion 12 into the stabilizing portion 14 and theeye E until the rim 24 of the cutting portion 12 engages the top surface29 of the stabilizing portion 14 (FIG. 5). As previously mentioned, therim 24 functions as a stop to the limit the distance the cutter 20 maybe inserted into the eye. Once fully inserted, the user may freelyrotate the cutting portion 12 in the direction Z₁ and/or Z₂ (FIG. 5).After the desired cut has been made, the user may remove the cuttingportion 12 from the eye E and stabilizing portion 14 by pulling thecutting portion in the direction of the action arrow B in FIG. 4. Atthis point, the user may remove the transplant material by simplylifting it from the eye E. One will appreciate that the presentconfiguration of the stabilizing portion 14 and cutting portion 12enables a user to accurately remove cornea material, as well as aportion of the sclera region of the eye, if desired. After thetransplant material has been removed, the user may remove thestabilizing portion from the eye E.

In another embodiment shown in FIGS. 7-13 d, the cutting portion 12includes threads 22 positioned adjacent the cutter 20 (see FIG. 9). Thethreads 22 are adapted to engage matching threads 36 (FIGS. 13 a-13 d)positioned on the inside of the stabilizing portion 14. This embodimentof the cutting portion 12 also includes the projection or rim 24positioned between the threads 22 and gripping portion 18. As discussedbelow in further detail, the rim 24 engages a recess 26 (FIGS. 13 a-13d) of the stabilizing portion 14, therein functioning as a stop to limitthe distance the cutter 20 may extend beyond the stabilizing portion 14.

With specific reference to FIG. 8, the stabilizing portion 14 mayinclude a substantially cylindrical region or tube 25 having astabilizer 30 and a flared region 27 having a second gripping portion28. As shown, the stabilizer 30 includes a serrated edge 32 formed froma plurality of teeth 32 a. In one embodiment, the serrated edge 32includes twelve teeth equally spaced about the circumference of the tube25 for engagement with an eye E (FIGS. 13 c and 13 d). The stabilizer 30functions to prevent movement of the stabilizing portion during theprocess of obtaining transplant material. Although shown with a flaredportion 34, the stabilizing portion 14 may have any diameter thatenables insertion of the cutting portion 12.

To assemble and use this embodiment of the device 10, the user insertsthe cutting portion 12 into the stabilizing portion 14. With referenceto FIG. 13 b, the threads 22 of the cutting portion 12 engage thethreads 36 of the stabilizing portion 14 in a standard screwarrangement. At this point, the device 10 is ready for engagement withthe eye E.

One will appreciate that, prior to engagement with the eye E, the cutter20 does not extend beyond a plane P defined by the serrated edge 32(FIG. 13 b). Since the tube 16 of the cutting portion 12 and the tube 25of the stabilizing portion 14 are substantially hollow, the user of thedevice may accurately align the device 10 on the eye E by sightingthrough the device 10.

As shown in FIG. 13 c, the user places the device 10 such that theserrated edge 32 engages the eye E and prevents undesired rotation ofthe stabilizing portion 14 during the excision process. Unlike theprevious embodiment where the stabilizing portion 14 became inserted inthe eye E, the present embodiment only rests on the sclera S of the eyeE. Once positioned, the user may begin turning the cutting portion 12 tocut the eye E. As shown in FIG. 13 c, the cutting portion 12 is turnedin a direction Z₃ such that is proceeds in a direction Y along thethreads 36 of the stabilizing portion 14.

The cutter 20 continues to cut until the rim 24 engages the recess 26(FIG. 13 d). A skilled artisan will appreciate that the engagement ofthe rim 24 in the recess 26 prevents any further cutting beyond adesired point. This ensures that the user does not make a cut that istoo deep or not deep enough.

In other embodiments, the cutting portion 12 may also include a flaredregion 27′. As shown in FIG. 14, one end of the cutting portion 12includes the flared region 27′, while the other end includes the cutter20. The flared region 27′ on the cutting portion 12 provides a largergripping surface for the user of the device 10, as well as greatervisibility of the eye E when aligning the device 10. Similar to theprevious embodiments, the stabilizing portion 14 with the flared region27′ may also include a stop 37 for limiting the distance the cutter 20may extend beyond the plane P′. Alternatively, a shoulder 39 of theflared region 27′ may function to limit the cutting distance.Specifically, the shoulder 39 may engage a surface, such as the topsurface 41, of the stabilizing portion 14 when inserted, thereinlimiting the distance the cutter 20 may extend and obviating the needfor the stop 37. Although shown in FIG. 14 as including thesubstantially cylindrical tube 16 between the flared region 27′ and thecutter 20, the flared region 27′ may terminate with the cutter 20,thereby eliminating the need for the cylindrical tube 16.

In any of the embodiments shown in FIG. 14, the cutting portion 12becomes inserted into the stabilizing portion 14 in the direction A′. Aswith the previously discussed embodiment, the threads 22 of the cuttingportion 12 engage the threads of the stabilizing portion 14. Prior toengagement with the eye E, the cutter 20 does not extend beyond a planeP′ defined by the edge 31 of the stabilizer 30.

Similar to the recess 26 in the previous embodiment, the stabilizingportion 14 may also include a stop 37, such as a projection or recessfor limiting the distance the cutter may extend beyond the plane P′. Asthe cutting portion 12 becomes inserted in the stabilizing portion 14,the rim 24 engages the stop 37, therein functioning to limit thedistance the cutter 20 may extend beyond the plane P′. Depending on thedesired depth of cut, this stop 37 may be positioned at any point alongthe interior of the tube 25. The stop 37 may also be positioned in theflared region 27, if desired.

Identical to the operation of the device 10 as previously discussed, theuser aligns the device 10 on the eye E by sighting through thesubstantially hollow tube 16 of the cutting portion 12 and the tube 25of the stabilizing portion 14. As previously discussed, positioning thestabilizer 30 at the flared region 27 enables the user to insert thedevice into the eye E, such that the flared region 27 encircles aportion of the eye E. This causes a portion of the stabilizer 30 toengage the conjunctival formix C.

In any of the embodiments, the device 10 may be configured for anycutting distance. Preferably, the cutter 20 is configured to extend adistance Y₁ of 0.1-1.4 mm into the eye E (FIGS. 13 c and 13 d). Uponcompletion of the single cut, the cutter 20 may become disconnected fromthe eye E by rotating the cutting region 12 in a direction Z₄, oppositefrom the direction Z₃ (FIGS. 13 c and 13 d). At this point, the device10 may be removed from the eye E and the transplant material may simplybe lifted from the eye E. One will appreciate that the device 10 mayobtain transplant material including the cornea, as well as 2-4 mm ofthe sclera region of the eye. In the event that the donor's eye socketis too small to receive the stabilizing portion 14, the user may extendthe cutter 20 and score the area of the cornea to be removed viascissors or other surgical tools.

The foregoing descriptions of various embodiments of the invention areprovided for purposes of illustration, and are not intended to beexhaustive or limiting. Modifications or variations are also possible inlight of the above teachings. For example, the device 10 may include anauxiliary handle for further control of the device. In addition toobtaining transplant material, the device 10 may be modifieddimensionally or otherwise for use in the eye of the recipient of thetransplant material and/or for obtaining the button to be transplanted.Also, in any of the embodiments, the cutter 20 may be a separate piecefrom the cutting portion 12. Thus, the cutter 20 may be inserted andremoved from the cutting portion 12, as desired. Alternatively, thecutter 20 may comprise a semi-permanent attachment to the cuttingportion via friction fit, brazing, welding or otherwise. The embodimentsdescribed above were chosen to provide the best application to therebyenable one of ordinary skill in the art to utilize the disclosedinventions in various embodiments and with various modifications as aresuited to the particular use contemplated. All such modifications andvariations are within the scope of the invention.

1. A device capable of cutting or scoring an eye, comprising: astabilizing portion having a first opening adapted to engage theconjunctival formix of the eye when inserted in the eye, and a secondopening adapted to receive a cutting portion having a cutter capable ofcutting or scoring the eye.
 2. The corneal excision or scoring device ofclaim 1, wherein the stabilizing portion is substantially hollow and thediameter of the first opening is greater than the diameter of the secondopening.
 3. The corneal excision or scoring device of claim 1, a flaredregion of the stabilizing portion includes the first opening.
 4. Thecorneal excision or scoring device of claim 1, wherein the stabilizingportion and the cutting portion comprise substantially concentric tubes.5. The corneal excision or scoring device of claim 4, wherein the cuttercomprises a substantially circular blade having an uninterrupted edge.6. The corneal excision or scoring device of claim 1, wherein thecutting portion comprises a substantially cylindrical tube having agripping portion at one end and the cutter at the other end.
 7. Thecorneal excision or scoring device of claim 6, wherein the cuttercomprises a blade substantially following a perimeter of the tube. 8.The corneal excision or scoring device of claim 6, wherein the tubefurther includes a projection positioned between the cutter and thegripping portion, the projection limits the depth of the cutting orscoring when it engages at least a portion of the stabilizing portion.9. The corneal excision or scoring device of claim 8, wherein theprojection comprises a substantially circular rim having a diametergreater than a diameter of the substantially cylindrical tube.
 10. Thecorneal excision or scoring device of claim 9, wherein the stabilizingportion includes a gripping portion at one end and a flared region atthe other end, the flared region assisting a user in engaging thestabilizing portion with the conjunctival formix.
 11. A device capableof cutting or scoring an eye, comprising: a stabilizing portion having asurface, the stabilizing portion for inserting in the eye to manipulatethe position of the eye; and a cutting portion having a substantiallyuninterrupted sidewall positioned between a cutter and a projectionpositioned on an exterior of the sidewall, the cutting portion forinserting inserted into the stabilizing portion to cut or score the eye,wherein engagement of the projection with the surface of the stabilizingportion functions to limit the distance the cutting portion may beinserted into the stabilizing portion.
 12. The corneal excision orscoring device of claim 11, wherein the stabilizing portion and thecutting portion are substantially hollow concentric tubes.
 13. Thecorneal excision or scoring device of claim 11, wherein the stabilizingportion has a first opening adapted to encircle the eye, such that atleast a portion of the stabilizing portion engages the conjunctivalformix of the eye when inserted in the eye.
 14. The corneal excision orscoring device of claim 13, wherein the stabilizing portion has a secondopening adapted to receive the cutting portion, the diameter of thefirst opening is greater than the diameter of the second opening. 15.The corneal excision or scoring device of claim 14, wherein the cuttingportion comprises a substantially hollow tube and the cutter comprises ablade substantially following a perimeter of the tube.
 16. The cornealexcision or scoring device of claim 15, wherein the projection comprisesa substantially circular rim having a diameter greater than a diameterof the tube.
 17. A method of corneal excision or scoring an eye,comprising: engaging the conjunctival formix of the eye; and cutting orscoring the eye.
 18. The method of corneal excision or scoring of claim17, wherein the engaging step comprises encircling the eye.
 19. Themethod of corneal excision or scoring of claim 18, wherein the engagingstep comprises inserting a stabilizing portion of a corneal excision orscoring device into the eye, such that a portion of the stabilizingportion engages the conjunctival formix of the eye.
 20. The method ofcorneal excision or scoring of claim 19, wherein the cutting or scoringcomprises inserting a cutting portion into the stabilizing portion tocut or score the eye.
 21. A method of corneal excision or scoring,comprising aligning a stabilizing portion of a corneal excision orscoring device on an eye; inserting the stabilizing portion into theeye, such that a portion of the stabilizing portion engages theconjunctival formix of the eye; manipulating the eye to a desiredposition; and inserting a cutting portion into the stabilizing portionto cut or score the eye.
 22. The method of corneal excision or scoringof claim 21, wherein the inserting the cutting portion step comprisesinserting until a projection engages a stop.
 23. The method of cornealexcision or scoring of claim 22, wherein the inserting the cuttingportion step comprises inserting the cutting portion to cut or score anarea 2-4 mm away from a limbus of the eye.
 24. The method of cornealexcision or scoring of claim 21, wherein inserting the stabilizingportion comprises inserting a stabilizing portion having an openingpositioned in a flared region.